Nicholas Mahoney1,2, Tracy Gladstone3, Daniela DeFrino2, Allison Stinson2, Jennifer Nidetz2, Jason Canel4, Eumene Ching5, Anita Berry6, James Cantorna7, Joshua Fogel2,8, Milton Eder9, Megan Bolotin2, Benjamin W Van Voorhees2. 1. Department of Psychiatry, University of Wisconsin Hospital and Clinics, Madison, Wisconsin. 2. Department of General Pediatrics, College of Medicine, University of Illinois at Chicago, Illinois. 3. The Robert S. and Grace W. Stone Primary Prevention Initiatives, Wellesley Centers for Women, Wellesley College. 4. Northshore University Health Systems, Evanston, Illinois. 5. Harvard Vanguard, Boston, Massachusetts. 6. Advocate Children's Hospital, Downers Grove, Illinois. 7. Franciscan Medical Specialists, Munster, Indiana. 8. Department of Business Management, Brooklyn College, New York. 9. Access Community Health Network, Chicago, Illinois.
Abstract
BACKGROUND AND PURPOSE: Depression affects millions of adolescents in the United States each year. This population may benefit from targeted preventive interventions. We sought to understand the internal factors that affect the ability of healthcare organizations to implement an intervention that involves mental health screening and depression prevention treatment of at-risk adolescents in primary care settings. METHODS: From November 2011 to July 2016 we conducted a study of the implementation of a multisite (N=30) phase 3 randomized clinical trial of an Internet-based depression prevention intervention program (CATCH-IT). We describe the prevalence of internal barriers on the screening and enrollment process by reporting REACH (the proportion of target audience exposed to the intervention). RESULTS: A total of 369 adolescents were randomized into the intervention or control program. Mean REACH values for the study clinics were 0.216 for screening and 0.181 for enrollment to CATCH-IT. Mean REACH enrollment lost due to internal barriers was 0.233. This translated to 4,691 adolescents lost at screening and 2,443 adolescents lost at enrollment due to internal barriers. CONCLUSION: We propose a model of the implementation process that emphasizes the importance of positive relational work that assists in overcoming internal barriers to REACH. We also provide implications for policy and practice.
BACKGROUND AND PURPOSE: Depression affects millions of adolescents in the United States each year. This population may benefit from targeted preventive interventions. We sought to understand the internal factors that affect the ability of healthcare organizations to implement an intervention that involves mental health screening and depression prevention treatment of at-risk adolescents in primary care settings. METHODS: From November 2011 to July 2016 we conducted a study of the implementation of a multisite (N=30) phase 3 randomized clinical trial of an Internet-based depression prevention intervention program (CATCH-IT). We describe the prevalence of internal barriers on the screening and enrollment process by reporting REACH (the proportion of target audience exposed to the intervention). RESULTS: A total of 369 adolescents were randomized into the intervention or control program. Mean REACH values for the study clinics were 0.216 for screening and 0.181 for enrollment to CATCH-IT. Mean REACH enrollment lost due to internal barriers was 0.233. This translated to 4,691 adolescents lost at screening and 2,443 adolescents lost at enrollment due to internal barriers. CONCLUSION: We propose a model of the implementation process that emphasizes the importance of positive relational work that assists in overcoming internal barriers to REACH. We also provide implications for policy and practice.
Entities:
Keywords:
adolescent; delivery of health care; health care reform; mental health; primary health care
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